<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><a style="color: red">*</a>{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" data-rule="required;length(~20)" name="row[name]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><a style="color: red">*</a>{:__('Mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" data-rule="required;length(~11)" name="row[mobile]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><a style="color: red">*</a>{:__('Emergency_description')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-emergency_description" data-rule="required;length(~200)" class="form-control " rows="5" name="row[emergency_description]" cols="50"></textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><a style="color: red">*</a>{:__('Forward_remarks')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-forward_remarks" data-rule="required;length(~200)" class="form-control " rows="5" name="row[forward_remarks]" cols="50"></textarea>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
